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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1095862



Case Details

VAERS ID: 1095862 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-23
Onset:2021-02-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Diarrhoea, Hypersomnia, Hypophagia
SMQs:, Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Alzheimers
Preexisting Conditions: Alzheimers
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: received a phone call from the daughter of the patient. On 01/21/2021, patient came in and got his first Covid Vaccination. 3 days after the vaccination, the patient experienced really bad diarrhea, and was sleeping for 22 hours a day. 2 weeks later he perked up a little bit. On 02/23/2021, patient received his booster. Daughter states that 2 days later, patient shut down completely, not eating or drinking. The patient ended up passing away on 03/05/2021.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1095862

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